U.S. patent application number 10/027520 was filed with the patent office on 2002-12-19 for method of treating dry eye disease with purinergic receptor agonists.
Invention is credited to Jacobus, Karla, Pendergast, William, Rideout, Janet L., Yerxa, Benjamin R..
Application Number | 20020193340 10/027520 |
Document ID | / |
Family ID | 31721322 |
Filed Date | 2002-12-19 |
United States Patent
Application |
20020193340 |
Kind Code |
A1 |
Yerxa, Benjamin R. ; et
al. |
December 19, 2002 |
Method of treating dry eye disease with purinergic receptor
agonists
Abstract
This invention is directed to a method of stimulating tear
secretion and mucin production in eyes. The method comprises the
step of administering to the eyes of a subject a composition
comprising a compound of Formula I, II, III, or IV and its
pharmaceutically acceptable salts, in an amount effective to
stimulate tear fluid secretion. The method of the present invention
may be used to increase tear production for any reason, including,
but not limited to, treatment of dry eye disease and corneal
injury. Pharmaceutical formulations and methods of making the same
are also disclosed. Methods of administering the same would
include: topical administration via a liquid, gel, cream, or as
part of a contact lens or selective release membrane; or systemic
administration via nasal drops or spray, inhalation by nebulizer or
other device, oral form (liquid or pill), injectable,
intra-operative instillation or suppository form.
Inventors: |
Yerxa, Benjamin R.;
(Raleigh, NC) ; Jacobus, Karla; (Cary, NC)
; Pendergast, William; (Durham, NC) ; Rideout,
Janet L.; (Raleigh, NC) |
Correspondence
Address: |
HOWREY SIMON ARNOLD & WHITE, LLP
BOX 34
301 RAVENSWOOD AVE.
MENLO PARK
CA
94025
US
|
Family ID: |
31721322 |
Appl. No.: |
10/027520 |
Filed: |
December 19, 2001 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10027520 |
Dec 19, 2001 |
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09171169 |
Oct 14, 1998 |
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09171169 |
Oct 14, 1998 |
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PCT/US98/02701 |
Feb 6, 1998 |
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09171169 |
Oct 14, 1998 |
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08797472 |
Feb 6, 1997 |
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5900407 |
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Current U.S.
Class: |
514/47 ;
514/48 |
Current CPC
Class: |
Y10S 514/912 20130101;
A61K 45/06 20130101 |
Class at
Publication: |
514/47 ;
514/48 |
International
Class: |
A61K 031/7084 |
Claims
What is claimed is:
1. A method of stimulating tear secretion and mucin production in
eyes of a subject comprising the step of administering to the eyes
of the subject an effective amount of a composition comprising a
compound of Formula II and its pharmaceutically acceptable salts
thereof: 7wherein: X is oxygen, imido, methylene or
difluoromethylene; Y is H or OH; Y' is H or OH; n=0, 1, or 2; m=0,
1, or 2; n+m=0-4; and B and B' are each independently a purine
residue, as in Formula IIa, linked through the 9- position:
8wherein: R.sub.X is O, H or is absent; R.sub.Y is hydrogen,
chlorine, amino, monosubstituted amino, disubstituted amino,
alkylthio, arylthio, or aralkylthio, wherein the substituent on
sulfur contains up to a maximum of 20 carbon atoms, with or without
unsaturation; R.sub.Z is oxo, mercapto, thione, alkylthio,
arylthio, aralkylthio, acylthio, alkyloxy, aryloxy, aralkyloxy,
acyloxy, amino, mono-substituted amino or di-substituted amino;
R.sub.3 is hydrogen, azido, alkoxy, aryloxy, aralkyloxy, alkylthio,
arylthio, aralkylthio, amino, mono-substituted amino,
di-substituted amino, or T(C.sub.1-6alkyl)OCONH(C.sub.1-6alkyl)W
wherein T and W are independently amino, mercapto, hydroxy or
carboxyl, or pharmaceutically acceptable esters, amides or salts
thereof.
2. The method according to claim 1, wherein said B and B' are
adenine.
3. The method according to claim 2, wherein said n+m=2, 3, or 4,
and said X=O.
4. The method according to claim 1, wherein said method is
effective in treating dry eye disease.
5. The method according to claim 1, wherein said method is
effective in treating corneal injury.
6. The method according to claim 1, wherein said administering is
topical or systemic administering.
7. The method according to claim 6, wherein said topical
administering of said composition is carried out via a carrier
vehicle selected from a group consisting of drops of liquid, liquid
wash, gels, ointments, sprays and liposomes.
8. The method according to claim 6, wherein said topical
administering comprises infusing said composition to said ocular
surface via a device selected from a group consisting of a
pump-catheter system, a continuous or selective release device, and
a contact lens.
9. The method according to claim 6, wherein said systemic
administering is carried out via a liquid/liquid suspension via
nose drops, nasal spray, or nebulized liquid, to oral or
nasopharyngeal airways of said subject, such that a therapeutically
effective amount of said compound contacts the lacrimal tissues of
said subject via systemic absorption and circulation.
10. The method according to claim 6, wherein said systemic
administering is carried out by administering an oral form, an
injectable form, or a suppository form of said compound, such that
a therapeutically effective amount of said compound contacts the
lacrimal tissues of said subject via systemic absorption and
circulation.
11. The method according to claim 6, wherein said systemic
administering is carried out by administering an intra-operative
instillation of a gel, cream, powder, foam, crystals, liposomes,
spray or liquid suspension form of said compound, such that a
therapeutically effective amount of said compound contacts the
lacrimal tissues of said subject via systemic absorption and
circulation.
12. The method according to claim 1, wherein said compound is
administered in an amount sufficient to achieve concentrations
thereof on the ocular surfaces of said subject of from about
10.sup.-7 to about 10.sup.-1 moles/liter.
13. A method of stimulating tear secretion and mucin production in
eyes of a subject comprising the step of administering to the eyes
of the subject an effective amount of a composition comprising
P.sup.1, P.sup.4-di(adenosine-5'-)tetraphosphate, P.sup.1,
P.sup.5-di(adenosine-5'- -)pentaphosphate, P.sup.1,
P.sup.6-di(adenosine-5'-)hexaphosphate, P.sup.1-(cytidine 5'-)
P.sup.4-(uridine 5'-) tetraphosphate, P.sup.1-(deoxycytidine 5'-)
P.sup.4-(uridine 5'-) tetraphosphate,
P.sup.1-(bromophenylethenocytidine 5'-) P.sup.4-(uridine 5'-)
tetraphosphate, or P.sup.1-(inosine 5'-) P.sup.4-(uridine 5'-)
tetraphosphate, and its pharmaceutically acceptable salt
thereof.
14. A method of treating dry eye disease of a subject comprising
the step of administering to the eyes of the subject an effective
amount amount of a composition comprising comprising P.sup.1,
P.sup.4-di(adenosine-5'-)tet- raphosphate, P.sup.1,
P.sup.5-di(adenosine-5'-)pentaphosphate, P.sup.1,
P.sup.6-di(adenosine-5'-)hexaphosphate, P.sup.1-(cytidine 5'-)
P.sup.4-(uridine 5'-) tetraphosphate, P.sup.1-(deoxycytidine 5'-)
P.sup.4-(uridine 5'-) tetraphosphate,
P.sup.1-(bromophenylethenocytidine 5'-) P.sup.4-(uridine 5'-)
tetraphosphate, or P.sup.1-(inosine 5'-) P.sup.4-(uridine 5'-)
tetraphosphate, and its pharmaceutically acceptable salt
thereof.
15. A method of treating corneal injury of a subject comprising the
step of administering to the eyes of the subject an effective
amount amount of a composition comprising P.sup.1,
P.sup.4-di(adenosine-5'-)tetraphosphate- , P.sup.1,
P.sup.5-di(adenosine-5'-)pentaphosphate, P.sup.1,
P.sup.6-di(adenosine-5'-)hexaphosphate, P.sup.1-(cytidine 5'-)
P.sup.4-(uridine 5'-) tetraphosphate, P.sup.1-(deoxycytidine 5'-)
P.sup.4-(uridine 5'-) tetraphosphate,
P.sup.1-(bromophenylethenocytidine 5'-) P.sup.4-(uridine 5'-)
tetraphosphate, or P.sup.1-(inosine 5'-) P.sup.4-(uridine 5'-)
tetraphosphate, and its pharmaceutically acceptable salt thereof.
Description
[0001] This application is a continuation-in-part of U.S.
application Ser. No. ______ (Attorney Docket No.
03678.0023.CNUS04), filed Nov. 9, 2001; which is a continuation of
U.S. application Ser. No. 09/171,169, filed Oct. 14, 1998; which
was the National Stage of International Application No.
PCT/US98/02701, filed Feb. 6, 1998, published Aug. 13, 1998 under
PCT Article 21(2) in English; and was a continuation-in-part of
U.S. application Ser. No. 08/797,472 filed Feb. 6, 1997.
TECHNICAL FIELD
[0002] This invention relates to a method of regulating secretions
in and around the eye of a patient by administering purinergic
receptor agonists such as certain uridine, adenine, or cytidine
triphosphates as well as other dinucleoside polyphosphate
compounds.
[0003] This invention also relates to a method of enhancing
drainage of the lacrimal system by administering a pharmacologic
agent that enhances mucociliary clearance of the nasolacrimal duct
of a mammal. These agents include certain uridine, adenine and
cytidine triphosphates as well as other dinucleoside polyphosphate
compounds.
BACKGROUND OF THE INVENTION
[0004] There are many situations where it is therapeutically
desirable to increase the amount of tear fluid produced by the eye.
Dry eye disease is the general term for indications produced by
abnormalities of the precorneal tear film characterized by a
decrease in tear production or an increase in tear film
evaporation, together with the ocular surface disease that results.
Approximately 38 million Americans are affected with some type of
dry eye disorder. Among the indications that are referred to by the
general term "dry eye disease" are: keratoconjunctivitis sicca
(KCS), age-related dry eye, Stevens-Johnson syndrome, Sjogren's
syndrome, ocular cicatrical pemphigoid, blepharitis, corneal
injury, infection, Riley-Day syndrome, congenital alacrima,
nutritional disorders or deficiencies (including vitamins),
pharmacologic side effects, eye stress and glandular and tissue
destruction, environmental exposure to smog, smoke, excessively dry
air, airborne particulates, autoimmune and other immunodeficient
disorders, and comatose patients rendered unable to blink.
[0005] A healthy precorneal tear film has several important
functions: 1) to protect the cornea from desiccation; 2) to aid in
the immune response to infections; 3) to enhance oxygen permeation
into the cornea; and 4) to allow gliding movement of the eyeball
and eyelids. There are two structures responsible for maintaining
the properties of the tear film--the lacrimal glands and the
conjunctiva (the mucous membrane which surrounds part of the
eyeball and inner eyelids). These structures maintain the tear film
via regulation of water and electrolyte transport and via mucin
release by goblet cells.
[0006] The progression of dry eye disease is characterized by four
main "milestones." The first milestone is a decrease in tear
production. In rabbit models, this decrease in tear production has
been shown to correlate with an increase in tear osmolarity. The
second milestone is a loss of mucous-containing conjunctival goblet
cells. This decrease in goblet cell density becomes evident several
weeks after the onset of decreased tear production. The third
milestone in the progression of dry eye disease occurs about 1 year
later when desquamation of the corneal epithelium is observed. The
fourth and last milestone of the disease is a destabilization of
the cornea-tear interface (Gilbard, CLAO Journal, 22(2), 141-45
(1996)).
[0007] Currently, the pharmaceutical treatment of dry eye disease
is mostly limited to administration of artificial tears (saline
solution) to temporarily rehydrate the eyes. However, relief is
short-lived and frequent dosing is necessary. In addition,
artificial tears often have contraindications and incompatibility
with soft contact lenses (Lemp, Cornea, 9(1), S48-550 (1990)). The
use of phosphodiesterase inhibitors, such as
3-isobutyl-1-methylxanthine (IBMX) to stimulate tear secretion is
disclosed in U.S. Pat. No. 4,753,945. The effectiveness of these
phosphodiesterase inhibitors is currently being investigated
(Gilbard, et al., Arch. Ophthal, 112, 1614-16 (1994) and 109,
672-76 (1991); idem, Inv. Ophthal. Vis. Sci. 31, 1381-88 (1990)).
Stimulation of tear secretion by topical application of melanocyte
stimulating hormones is described in U.S. Pat. No. 4,868,154.
[0008] There are many situations where it is therapeutically
desirable to increase drainage of the lacrimal system. The lacrimal
system has two functioning components: the secretory part, which
produces tears, and the excretory part, which drains the tears into
the nose. When the lacrimal drainage system is not functioning
properly the result can be excessive tearing (epiphora),
mucopurulent discharge, and recurrent dacryocystitis (Shermataro,
et al., JAOA, 94, 229 (1994)). In fact, tearing is one of the most
common complaints that brings a patient to the ophthalmologist's
office (Conway, Ophthal. Plas. Reconstr. Surg., 10, 185
(1994)).
[0009] The most common malfunction of the lacrimal drainage system
is nasolacrimal duct obstruction, which results in stasis of tears
in the lacrimal sac. The accumulation of fluid and mucus results in
tearing and expulsion of mucopurulent material, causing the eyelids
to be "stuck together" on awakening in the morning. The lack of
clearance of the tear fluid also leads to inflammation and chronic
infection of the lacrimal sac and ducts (Hyde, et al., Ophthal.,
95, 1447 (1988); Blicker, et al., Ophthal. Plas. Reconstr. Surg.,
9, 43 (1993); Mauriello Jr., et al., Ophthal. Plast. Reconstr.
Surg., 8, 13 (1992)).
[0010] Nasolacrimal duct obstruction can be divided into two
etiologic classes: primary acquired nasolacrimal duct obstruction
(PANDO), which is characterized by hyperplasia and fibrosis of the
mucosal epithelium, and secondary acquired nasolacrimal duct
obstruction (SANDO), which is caused by cancer, inflammation,
infection, trauma and mechanical problems (Bartley, Ophthal. Plast.
Reconstr. Surg., 8, 237 (1992)). An occluded nasolacrimal duct is
more common in middle-aged women and infants. In fact, up to 20% of
all infants are affected by nasolacrimal duct obstruction with most
of them becoming symptom free by their first birthday (Young, et
al., Eye, 10, 485 (1996)).
[0011] Current treatments for nasolacrimal duct obstruction are
mostly invasive or surgical procedures that vary in aggressiveness.
Intervention can take the form of probing the duct with a fine
catheter; however, this is a difficult and delicate procedure that
requires special training and equipment (Kassoff, et al., Arch.
Ophthal., 113, 1168 (1995); Griffiths, U.S. Pat. Nos. 4,921,485
(1990) and 5,062,831 (1991); Becker, et al., U.S. Pat. Nos.
5,021,043 (1991) and 5,169,386 (1992)). In some cases silastic
intubation of the nasolacrimal duct increases drainage of tears
through the nasolacrimal duct (Dortzbach, et al., Amer. J Ophthal.,
94, 585 (1982); Al-Hussain, et al., Ophthal. Plas. Reconstr. Surg.,
9, 32 (1993); Crawford, et al. U.S. Pat. No. 4,380,239 (1983);
Ector, Jr., U.S. Pat. No. 4,658,816 (1987)). A more aggressive
procedure is a dacryo-cystorhinostomy which surgically creates a
new drainage path above the sight of obstruction allowing
continuity between the lacrimal sac and the nasal cavity (Linberg,
et al., Ophthal., 93, 1055 (1986); Tarbert, Ophthal., 102, 1065
(1995); O'Donnell, Jr., U.S. Pat. No. 5,3459,48 (1994)). External
massage of the nasolacrimal duct has also been shown to increase
tear transit times through the nasolacrimal duct (J. A. Foster, et
al., Ophthal. Plas. Reconstr. Surg., 12, 32 (1996)).
[0012] Thus, as a result of the ineffectiveness and inconvenience
of current therapies, medical researchers have sought to develop
alternatives for the treatment of dry eye disorders and
nasolacrimal duct disorders. It has been shown that uridine
5'-triphosphate (UTP) and adenine 5'-triphosphate (ATP) are potent
agonists of P2Y.sub.2 purinergic receptors found on the surface of
human airway epithelium. Activation of these P2Y.sub.2 purinergic
receptors induces chloride and water secretion, helping hydrate the
airway surface secretions. Use of UTP and ATP for the purpose of
treating pulmonary disorders characterized by the retention of lung
mucus secretions is described in U.S. Pat. No. 5,292,498. Because
of the demonstrated ability of UTP to increase hydration of airway
epithelial secretions, applicants were motivated to investigate
whether UTP and other P2Y.sub.2 and P2Y.sub.4 purinergic receptor
agonists could also stimulate hydration of ocular epithelia.
[0013] It had previously been shown that P2 type purinergic
receptors in rat and mouse lacrimal acinar cells responded to
extracellular ATP by increasing intracellular calcium (Sasaki, et
al., Febs Lett. 264, 130-34 (1990); idem, J. Physiol,. 447, 103-18
(1992);Vincent, J. Physiol., 449, 313-31 (1992); Gromada, et al.,
Eur. J. Physiol., 429, 578 (1995); Lee, et al. Inv. Ophthal. Vis.
Sci., 38(4)(1997) abstract).
[0014] The discovery of diadenosine 5'-polyphosphates (Ap.sub.nA,
n=2-7) and their release from platelets and chromaffin cells has
led to many studies of the biological activity and cellular
processing of these intra- and extracellular signalling molecules
(Pintor, Nervous Control of the Eye, 171-210 (1999); Hoyle et al.,
Drug Dev Res, 52:260-273 (2001)). Diadenosine polyphosphates have
interesting pharmacological effects on nucleotide receptors; that
is, depending on the chain length, they may be agonists or
antagonists at P2X and P2Y receptors with varying selectivity.
There is not a clear relationship between the phosphate chain
length and the selective activity on P2X or P2Y receptors; however,
from a physiological point of view, some of them can act as
vasodilators (Ap.sub.2A and Ap.sub.3A) while others act as
vasoconstrictors (Ap.sub.4A, Ap.sub.5A and Ap.sub.6A) (Ralevic, et
al., Pharmacol Rev, 50:413-492 (1998)).
[0015] Diadenosine polyphosphates were found to be potent and full
agonists in cells overexpressing the human P2Y.sub.2 receptor
(Lazarowski et al., Br J Pharmacol, 116:1619-1627 (1995). The avian
P2Y.sub.1 receptor is sensitive to Ap.sub.4A, presenting EC.sub.50
values in the nM range (Pintor et al., Br J Pharmacol,
119:1006-1012 (1996). Important differences have been observed on
native P2Y.sub.1 receptors, where diadenosine tetraphosphate
behaved as an antagonist in clear contrast with the behavior of
this dinucleotide in cloned P2Y.sub.1 receptors (Vigne et al., Br J
Pharmacol, 129:1506-1512 (2000). On the other hand, other expressed
P2Y receptors, such as P2Y.sub.4 are also activated by
Ap.sub.3A-Ap.sub.6A in the micromolar range (Communi, et al., Eur J
Pharmacol 317:383-389 (1996); Janssens et al., Biochem Biophys Res
Commun, 236:106-112 (1997)).
SUMMARY OF THE INVENTION
[0016] This invention is directed to a method of stimulating tear
secretion and mucin production in eyes. The method comprises the
step of administering to the eyes of a subject a composition
comprising a compound of Formula I, II, I, or IV and its
pharmaceutically acceptable salts, in an amount effective to
stimulate tear fluid secretion. The method of the present invention
may be used to increase tear production for any reason, including,
but not limited to, treatment of dry eye disease and corneal
injury.
[0017] The method of the present invention comprises topically
administering a liquid or gel composition comprising an effective
amount of a P2Y.sub.2 and/or P2Y.sub.4 purinergic receptor agonist
selected from the group consisting of uridine triphosphate (UTP)
and its analogs, P.sup.1, P.sup.4-di(uridine-5'-)tetraphosphate
(U.sub.2P.sub.4) and its analogs, P.sup.1,
P.sup.4-di(adenosine-5'-)tetraphosphate (A.sub.2P.sub.4) and its
analogs, P.sup.1, P.sup.5-di(adenosine-5'-)penta- phosphate
(A.sub.2P.sub.5) and its analogs,, or P.sup.1,
P.sup.6-di(adenosine-5'-)hexaphosphate (A.sub.2P.sub.6) and its
analogs, cytidine 5'-triphosphate (CTP) and its analogs, and
adenosine 5'-triphosphate (ATP) and its analogs.
[0018] Another aspect of the present invention is the use of a
compound of formula I-IV for the manufacture of a medicament for
carrying out a therapeutic method of treatment as given above.
[0019] Yet another aspect of the present invention is a
pharmaceutical composition comprising a compound of Formula I, II,
III, or IV, in a pharmaceutical carrier in an amount effective to
stimulate tear production or to enhance clearance of nasolacrimal
ducts in a subject in need of such treatment.
BRIEF DESCRIPTION OF THE FIGURES
[0020] FIG. 1 shows the tear secretion effects for 60 minutes after
a single dose of U.sub.2P.sub.4 at three concentrations in rabbit
eyes. The data shown are the mean of eight animals.
[0021] FIG. 2 shows the effects of dCp.sub.4U,
p-Br-phenyl-ethenoCp.sub.4U- , and U.sub.2P.sub.4 on Schirmer
scores in rabbits.
[0022] FIG. 3A shows the effects of ATP, UTP, ADP and UDP on tear
secretion. FIG. 3B shows the effect of Ap.sub.2A, Ap.sub.3A,
Ap.sub.4A, Ap.sub.5A and Ap.sub.6A on tear secretion.
[0023] FIG. 4 shows the concentration-effect curves of
dinucleotides Ap.sub.2A, Ap.sub.3A, Ap.sub.4A, Ap.sub.5A and
Ap.sub.6A. Diadenosine polyphosphates, Ap.sub.2A-Ap.sub.6A were
assayed at concentrations ranging from 10.sup.-10 g/.mu.l to
10.sup.-4 g/.mu.l. Transormation of g/.mu.l into M concentrations
was performed by taking into account the corresponding molecular
weight of each dinucleotide. Doses were applied in a non-cumulative
fashion in one of the rabbit eyes, with the contralateral eye
receiving the same volume of saline solution. Values are the mean
.+-.S.E.M. of eight independent experiments.
[0024] FIG. 5 shows the [Ca.sup.+2].sub.i responses to different
concentrations of Ap.sub.2A, Ap.sub.3A, Ap.sub.4A, Ap.sub.5A and
Ap.sub.6A: (A) P2Y.sub.1 receptor, (B) P2Y.sub.2 receptor.
DETAILED DESCRIPTION OF THE INVENTION
[0025] The present invention is directed to a method of stimulating
tear secretion and mucin production in eyes for any reason,
including, but not limited to, treatment of dry eye disease. Dry
eye disease is defined to include: keratoconjunctivitis sicca
(KCS), age-related dry eye, Stevens-Johnson syndrome, Sjogren's
syndrome, ocular cicatrical pemphigoid, blepharitis, corneal
injury, infection, Riley-Day syndrome, congenital alacrima,
nutritional disorders or deficiencies (including vitamin),
pharmacologic side effects, eye stress and glandular and tissue
destruction, environmental exposure to smog, smoke, excessively dry
air, airborne particulates, autoimmune and other immunodeficient
disorders, and comatose patients rendered unable to blink. The
present invention may also be useful as a wash or irrigation
solution in conscious individuals, during surgery or to maintain
comatose patients or those who cannot blink due to muscle or nerve
damage, neuromuscular blockade or loss of the eyelids. The present
invention may also be useful for treating corneal injury.
[0026] The present invention is also directed to a method of
enhancing drainage of the lacrimal system in a subject in need of
such treatment. The method of this aspect of the invention may be
used to enhance clearance of the nasolacrimal duct for any reason,
including, but not limited to, treatment of nasolacrimal duct
obstruction. Nasolacrimal duct obstruction is defined to include
both primary and secondary acquired nasolacrimal duct obstruction
and pediatric nasolacrimal duct obstruction. The present invention
may also be useful as a nasolacrimal wash or irrigation solution in
conscious individuals or during nasolacrimal duct surgery or
intubation. The compounds disclosed herein may also be used in
conjunction with mucolytic agents, such as DNAse, acetylcysteine
and bromhexine.
[0027] The present method of stimulating tear secretion and mucin
production in eyes and the present method of enhancing drainage of
the lacrimal system comprise the step of administering to the eyes
an effective amount of a composition comprising a compound of
P2Y.sub.2 and/or P2Y.sub.4 purinergic receptor agonist selected
from the group consisting of general Formula I, i.e., uridine
triphosphate (UTP) and its analogs; general Formula II, i.e.,
dinucleoside polyphosphate; general Formula III, i.e., cytidine
5'-triphosphate (CTP) and its analogs; and general Formula IV,
i.e., adenosine 5'-triphosphate (ATP) and its analogs, with the
compound of Formula I, II, III or IV administered in an amount
effective to stimulate tear secretion or to enhance clearance of
nasolacrimal duct obstruction.
[0028] Applicant has discovered that tear secretion can be
stimulated from lacrimal accessory tissues via P2Y.sub.2 and/or
P2Y.sub.4 purinergic receptor-mediated mechanisms similar to those
which hydrate airway epithelia. Applicant has also discovered that
stimulators of mucociliary clearance when applied topically to the
eye or injected into the nasolacrimal drainage system increases the
flow of tears through the nasolacrimal duct and hence relieves the
symptoms associated with nasolacrimal duct obstruction.
Active Compounds Useful for the Invention UTP and its analogs are
depicted in general Formula I:
[0029] 1
[0030] wherein:
[0031] X.sub.1, X.sub.2 and X.sub.3 are each independently either
O.sup.- or S.sup.-. Preferably, X.sub.2 and X.sub.3 are
O.sup.-.
[0032] R.sub.1 is O, imido, methylene or dihalomethylene (e.g.,
dichloromethylene or difluoromethylene). Preferably, R.sub.1 is
oxygen or imido.
[0033] R.sub.2 is H or Br. Preferably, R.sub.2 is H. Particularly
preferred compounds of Formula I are uridine 5'-triphosphate (UTP)
and uridine 5'-O-(3-thiotriphosphate) (UTP.gamma.S).
[0034] A dinucleotide is depicted by the general Formula II: 2
[0035] wherein:
[0036] X is oxygen, imido, methylene or difluoromethylene;
[0037] Y is H, or OH;
[0038] Y' is H, or OH;
[0039] n=0, 1, or 2;
[0040] m=0, 1, or 2;
[0041] n+m=0-4; and
[0042] B and B' are each independently a purine residue, as in
Formula IIa, or a pyrimidine residue, as in Formula IIb, linked
through the 9- or 1-position, respectively. In the instance where B
and B' are uracil, attached at the N-1 position to the ribosyl
moiety, then the total of m+n may equal 3 or 4 when X is oxygen.
The ribosyl moieties are in the D-configuration, as shown, but may
also be L-, or D- and L-. The D-configuration is preferred. 3
[0043] wherein:
[0044] R.sub.X is O, H or is absent;
[0045] R.sub.Y is hydrogen, chlorine, amino, monosubstituted amino,
disubstituted amino, alkylthio, arylthio, or aralkylthio, wherein
the substituent on sulfur contains up to a maximum of 20 carbon
atoms, with or without unsaturation;
[0046] R.sub.Z is oxo, mercapto, thione, alkylthio, arylthio,
aralkylthio, acylthio, alkyloxy, aryloxy, aralkyloxy, acyloxy,
amino, mono-substituted amino or di-substituted amino;
[0047] R.sub.3 is hydrogen, azido, alkoxy, aryloxy, aralkyloxy,
alkylthio, arylthio, aralkylthio, amino, mono-substituted amino,
di-substituted amino, or T(C.sub.1-6alkyl)OCONH(C.sub.1-6alkyl)W
wherein T and W are independently amino, mercapto, hydroxy or
carboxyl, or pharmaceutically acceptable esters, amides or salts
thereof.
[0048] Formula IIa includes substituted derivatives of adenine such
as adenine 1-oxide; 1, N6-(4- or 5-substituted etheno) adenine;
6-substituted adenine; or 8-substituted aminoadenine. Formula IIa
also includes inosine.
[0049] When R.sub.3 and R.sub.Z are independently NHR', R' is
hydrogen, arylalkyl (C.sub.1-6) groups with the aryl moiety
optionally functionalized as described below; alkyl; and alkyl
groups with functional groups therein, such as:
([6-aminohexyl]carbamoylmethyl)-, and
.omega.-acylated-amino(hydroxy, thiol and carboxy) derivatives
where the acyl group is chosen from among, but not limited to,
acetyl, trifluroroacetyl, benzoyl, substituted-benzoyl, etc., or
the carboxylic moiety is present as its ester or amide derivative,
for example, the ethyl or methyl ester or its methyl, ethyl or
benzamido derivative. The .omega.-amino(hydroxy, thiol) moiety may
be alkylated with a C.sub.1-4 alkyl group. 4
[0050] R.sub.4 is hydroxy, oxo, mercapto, thione, amino, cyano,
C.sub.7-12arylalkoxy, C.sub.1-6 alkylthio, C.sub.1-6 alkoxy,
C.sub.1-6 alkylamino or diC.sub.1-4alkylamino, wherein the alkyl
groups are optionally linked to form a heterocycle;
[0051] R.sub.5 is hydrogen, acetyl, benzoyl, C.sub.1-6 alkyl,
C.sub.1-5 alkanoyl, aroyl, or absent;
[0052] R.sub.6 is hydroxy, oxo, mercapto, thione, C.sub.1-4alkoxy,
C.sub.7-12arylalkoxy, C.sub.1-6alkylthio, S-phenyl, arylthio,
arylalkylthio, triazolyl amino, C.sub.1-6alkylamino, C.sub.1-5
disubstituted amino, or di-C.sub.1-4alkylamino, wherein said
dialkyl groups are optionally linked to form a heterocycle or
linked to form a substituted ring such as morpholino, pyrrolo;
or
[0053] R.sub.5 and R.sub.6 taken together form a 5-membered fused
imidazole ring of 3,N.sup.4-ethenocytosine derivatives between
positions 3 and 4 of the pyrimidine ring, wherein said etheno
moiety is optionally substituted on the 4- or 5-positions with
C.sub.1-4 alkyl, phenyl or phenyloxy; wherein at least one hydrogen
of said C.sub.1-4 alkyl, phenyl or phenyloxy is optionally
substituted with a moiety selected from the group consisting of
halogen, hydroxy, C.sub.1-4 alkoxy, C.sub.1-4 alkyl, C.sub.6-10
aryl, C.sub.7-12 arylalkyl, carboxy, cyano, nitro, sulfonamido,
sulfonate, phosphate, sulfonic acid, amino, C.sub.1-4 alkylamino,
or di-C.sub.1-4 alkylamino, wherein said dialkyl groups are
optionally linked to form a heterocycle;
[0054] R.sub.7 is hydrogen, hydroxy, cyano, nitro, C.sub.1-6 alkyl
or phenyl, substituted C.sub.2-8 alkynyl, halogen, substituted
C.sub.1-4 alkyl, CF.sub.3, C.sub.2-3 alkenyl, C.sub.2-3 alkynyl,
allylamino, bromovinyl, ethyl propenoate, propenoic acid or
C.sub.2-8 alkenyl; or
[0055] R.sub.6 and R.sub.7 together form a 5 or 6-membered
saturated or unsaturated ring bonded through N or O or S at
R.sub.6, such ring optionally contains substituents that themselves
contain functionalities;
[0056] R.sub.8 is hydrogen, amino, di-C.sub.1-4alkylamino,
C.sub.1-4alkoxy, C.sub.7-12arylalkoxy, C.sub.1-4alkylthio,
C.sub.7-12arylalkylthio, carboxamidomethyl, carboxymethyl, methoxy,
methylthio, phenoxy, or phenylthio; provided that when R.sub.8 is
amino or substituted amino, R.sub.7 is hydrogen.
[0057] In the general structure of Formula IIb above, the dotted
lines in the 2- to 6-positions are intended to indicate the
presence of single or double bonds in these positions; the relative
positions of the double or single bonds being determined by whether
the R.sub.4, R.sub.6 and R.sub.7 substituents are capable of
keto-enol tautomerism.
[0058] In the general structures of Formulae IIa and IIb above, the
acyl groups include alkanoyl or aroyl groups. The alkyl groups
contain 1 to 8 carbon atoms, particularly 1 to 4 carbon atoms
optionally substituted by one or more appropriate substituents, as
described below. The aryl groups including the aryl moieties of
such groups as aryloxy are preferably phenyl groups optionally
substituted by one or more appropriate substituents, as described
below. The above mentioned alkenyl and alkynyl groups
advantageously contain 2 to 8 carbon atoms, particulary 2 to 6
carbon atoms, e.g., ethenyl or ethynyl, optionally substituted by
one or more appropriate substituents as described below.
Appropriate substituents on the above-mentioned alkyl, alkenyl,
alkynyl, and aryl groups are selected from halogen, hydroxy,
C.sub.1-4 alkoxy, C.sub.1-4 alkyl, C.sub.7-12 arylalkoxy, carboxy,
cyano, nitro, sulfonamido, sulfonate, phophate, sulfonic, amino and
substituted amino wherein the amino is singly or doubly substituted
by a C.sub.1-4 alkyl, and when doubly substituted, the alkyl groups
optionally being linked to form a heterocycle.
[0059] Previously described dinucleotide polyphosphates are listed
in Table I, followed by literature references. These dinucleotide
polyphosphates are useful in the present invention.
1TABLE I DINUCLEOTIDES IN THE LITERATURE Np.sub.2N Np.sub.2N'
Np.sub.3N Np.sub.3N' Np.sub.4N Np.sub.4N' Np.sub.5N Np.sub.5N'
Np.sub.6N Np.sub.6N' Ap.sub.2A Ap.sub.2NAD Up.sub.3U Ap.sub.3T
Up.sub.4U Ap.sub.4U Ap.sub.5A Ap.sub.5T Ap.sub.6A Ap.sub.6T
Gp.sub.2G Ap.sub.2TAD Ap.sub.3A m.sup.7Gp.sub.3G Ap.sub.4A
Ap.sub.4C Up.sub.5U Ap.sub.5U Up.sub.6U Ap.sub.6U
m.sup.7Gp.sub.2m.sup.7G Ap.sub.2C-NAD Xp.sub.3X
m.sup.2,2,7Gp.sub.3G Cp.sub.4C Ap.sub.4G (5-BrU)p.sub.5(5-
Ap.sub.5(5-BrU) (5-BrU)p.sub.6(5- Up.sub.6(5-BrU) BrU) BrU)
Up.sub.2U Ap.sub.2C-PAD m.sup.7Gp.sub.3m.sup.7G m.sup.2,7Gp.sub.3G
Gp.sub.4G Gp.sub.4U Gp.sub.5G Up.sub.5(5-BrU) Gp.sub.6G
Ap.sub.6(5-BrU) (5-BrU)p.sub.2(5- Ap.sub.2BAD Gp.sub.3G Ap.sub.3U
Xp.sub.4X Gp.sub.4C 2'dGp.sub.52'dG BrU) Ip.sub.5I
(AZT)p.sub.2(AZT) m.sup.7Gp.sub.2G (5-BrU)p.sub.3(5-
Ap.sub.3(5-BrU) Dp.sub.4D Up.sub.4C BrU) (5FU)p.sub.2(5FU)
Ap.sub.2G Cp.sub.3C Up.sub.3(5-BrU) eAp.sub.4eA Ap.sub.4T Ip.sub.2I
Ap.sub.2U Ip.sub.3I Gp.sub.3A m.sup.7Gp.sub.4m.sup.7G
m.sup.7Gp.sub.4G Ap.sub.2(5-BrU) Ap-CH.sub.2-ppA Gp.sub.3C
(5-BrU)p.sub.4(5- m.sup.2,7Gp.sub.4G BrU) Up.sub.2(5-BrU)
Ap-CF.sub.2-ppA Gp.sub.3Gm dAp.sub.4dA m.sup.2,2,7Gp.sub.4G
(AZT)p.sub.2(5- Gp.sub.3Am 3'-dAp.sub.43'-dA (5-BrU)p.sub.4A FU)
Ap.sub.2T m.sup.7Gp.sub.3m.sup.6Am dGp.sub.4dG (5-BrU)p.sub.4U
Gp.sub.2A m.sup.7Gp.sub.3Gm ApCH.sub.2p.sub.3A Ap.sub.4(8-BrA)
Ip.sub.2A Ap.sub.3C Ip.sub.4I Ap.sub.4X 2dGp.sub.2A Ap.sub.3G
Ap.sub.2CH.sub.2p.sub.2A Ap.sub.4I Ap.sub.2C m.sup.7Gp.sub.3A
Ap.sub.2CF.sub.2p.sub.2A Ap.sub.4dA Ip.sub.3A
Dp.sub.2CH.sub.2p.sub.2D Ap.sub.4d(5-FU) Ip.sub.3G
Dp.sub.2CF.sub.2p.sub.2D Ap.sub.4araA 2'dGp.sub.3A
Ap.sub.2CH.sub.2p.sub.2U 2'dGp.sub.3-2'dG Ap.sub.2CH.sub.2p.sub.2G
m.sup.7Gp.sub.3Am Ap.sub.3CH.sub.2pT Gp.sub.3U ahaAp.sub.4A
m.sup.7Gp.sub.3Cm ahaAp.sub.4G m.sup.7Gp.sub.3Um m.sup.7Gp.sub.3G
App-CH.sub.2-pT Ap-CF.sub.2-ppA
[0060]
2 A = Adenosine eA = Ethenoadenosine U = Uridine m.sup.7G =
7-Methylguanosine G = Guanosine m.sup.2,7G = 2,7-Dimethylguanosine
T = Thymidine m.sup.2,2,7G = 2,2,7-Trimethylguanosine X =
Xanthosine NAD = nicotinamide riboside TAD = Tiazofurin C-NAD =
C-nicotinamide riboside BAD = Benzamide riboside C-PAD =
C-picolinamide riboside D = 2,6-Diaminopurine N = Nucleoside Gm =
2'-O- Am = 2'-O-methyladenosine methylguanosine m.sup.6Am =
N6-methyl-2'-O- Cm = 2'-O-methylcytidine methyladenosine Um =
2'-O-methyluridine aha = 8-(6-aminohexyl) AZT = Thymine-3'-azido2',
X = Xanthosine 3'-dideoxy-D- riboside 5-BrU = 5-bromouridine 5-FU =
5-fluorouridine A = Adenosine eA = Ethenoadenosine U = Uridine
m.sup.7G = 7-Methylguano- sine G = Guanosine m.sup.2,7G =
2,7-Dimethylguanosine T = Thymidine m.sup.2,2,7G =
2,2,7-Trimethylguanosine X = Xanthosine NAD = nicotinamide riboside
TAD = Tiazofurin C-NAD = C-nicotinamide riboside BAD = Benzamide
riboside C-PAD = C-picolinamide riboside D = 2,6-Diaminopurine N =
Nucleoside
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[0122] Preferred Formula II compounds for this invention are
P.sup.1, P.sup.4-di(uridine-5'-)tetraphosphate (U.sub.2P.sub.4),
P.sup.1, P.sup.4-di(adenosine 5'-)tetraphospate (Ap.sub.4A),
P.sup.1, P.sup.5-di(adenosine-5'-)pentaphosphate (Ap.sub.5A),
P.sup.1, P.sup.4-di(adenosine 5'-)tetraphosphate (Ap.sub.6A),
P.sup.1-(cytidine 5'-) P.sup.4-(uridine 5')-tetraphosphate
(Cp.sub.4U), P.sup.1-(deoxycytidine 5'-) P.sup.4-(uridine
5')-tetraphosphate (dCp.sub.4U),
P.sup.1-(bromophenyletheneocytidine 5'-) P.sup.4-(uridine
5'-)tetraphosphate, and P.sup.1-(inosine 5-) P.sup.4-(uridine 5'-)
tetraphosphate (IP.sub.4U).
[0123] ATP and its analogs are depicted by general Formula III:
5
[0124] wherein:
[0125] R.sub.1, X.sub.1, X.sub.2 and X.sub.3 are defined as in
Formula I.
[0126] R.sub.9 is O, H or absent;
[0127] R.sub.10 and R.sub.11 are H while R.sub.9 is absent and
there is a double bond between N-1 and C-6 (adenine), or
[0128] R.sub.10 and R.sub.11 are H while R.sub.9 is 0 and there is
a double bond between N-1 and C-6 (adenine 1-oxide), or
[0129] R.sub.9, R.sub.10 and R.sub.11 taken together are
--CH.dbd.CH--, forming a ring from N-6 to N-1 with a double bond
between N-6 and C-6 (1,N6-ethenoadenine).
[0130] CTP and its analogs are depicted by general Formula IV:
6
[0131] wherein:
[0132] R.sub.1, X.sub.1, X.sub.2 and X.sub.3 are defined as in
Formula I.
[0133] R.sub.12 and R.sub.13 are H while R.sub.14 is nothing and
there is a double bond between N-3 and C-4 (cytosine), or
[0134] R.sub.12, R.sub.13 and R.sub.14 taken together are
--CH.dbd.CH--, forming a ring from N-3 to N-4 with a double bond
between N-4 and C-4 (3,N.sup.4-ethenocytosine) optionally
substituted at the 4- or 5-position of the etheno ring.
[0135] For simplicity, Formulae I, II, III and IV herein illustrate
the active compounds in the naturally occurring D-configuration,
but the present invention also encompasses compounds in the
L-configuration, and mixtures of compounds in the D- and
L-configurations, unless otherwise specified. The naturally
occurring D-configuration is preferred.
[0136] The active compounds of the invention may also be present in
the form of their pharmaceutically acceptable salts, such as, but
not limited to, an alkali metal salt such as lithium, sodium or
potassium; an alkaline earth metal salt such as manganese,
magnesium or calcium; or an ammonium or tetraalkyl ammonium salt,
i.e., NX.sub.4.sup.+ (wherein X is C.sub.1-4). Pharmaceutically
acceptable salts are salts that retain the desired biological
activity of the parent compound and do not impart undesired
toxicological effects.
[0137] Applicant has discovered that compounds of Formulae I-IV are
potent agonists for purinergic receptors found in lacrimal gland
and conjunctival preparations. The method of the present invention
is an improvement upon the current most commonly used treatment of
dry eye disease--artificial tears (i.e., saline solution) because
the present method stimulates a patient's own tear production and
secretion, which maintain natural protective and lubricant
characteristics, and enhance healing of corneal injuries.
Furthermore, the method of the present invention may be useful even
where lacrimal glands are dysfunctional or absent. In addition, the
method of the present invention useful in enhancing clearance of
obstructed nasolacrimal ducts.
[0138] The present invention is concerned primarily with the
treatment of human subjects, but may also be employed for the
treatment of other mammalian subjects, such as dogs and cats, for
veterinary purposes.
[0139] Methods of Administration
[0140] The active compounds disclosed herein may be administered to
the eyes of a patient by any suitable means, but are preferably
administered by administering a liquid or gel suspension of the
active compound in the form of drops, spray or gel. Alternatively,
the active compounds may be applied to the eye via liposomes.
Further, the active compounds may be infused into the tear film via
a pump-catheter system. Another embodiment of the present invention
involves the active compound contained within a continuous or
selective-release device, for example, membranes such as, but not
limited to, those employed in the Ocusert.TM. System (Alza Corp.,
Palo Alto, Calif.). As an additional embodiment, the active
compounds can be contained within, carried by, or attached to
contact lenses which are placed on the eye. Another embodiment of
the present invention involves the active compound contained within
a swab or sponge which can be applied to the ocular surface.
Another embodiment of the present invention involves the active
compound contained within a liquid spray which can be applied to
the ocular surface. Another embodiment of the present invention
involves an injection of the active compound directly into the
lacrimal tissues or onto the eye surface.
[0141] The quantity of the active compound included in the topical
solution is an amount sufficient to achieve dissolved
concentrations of the active compound on the ocular surface of the
subject of from about 10.sup.-7 to about 10.sup.-1 moles/liter, and
more preferably from about 10.sup.-6 to about 10.sup.-1
moles/liter, in order to stimulate tear secretion or enhance
clearance of nasolacrimal ducts.
[0142] Depending upon the solubility of the particular formulation
of active compound administered, the daily dose to promote tear
secretion or enhance clearance of nasolacrimal duct clearance may
be divided among one or several unit dose administrations. The
total daily dose for U.sub.2P.sub.4 (for example) may range from a
regimen of 2 to 6 administrations per day of a solution with a
concentration of 0.25 mg/ml to 50 mg/ml, depending upon the age and
condition of the subject.
[0143] Some compounds of Formula I, III and IV can be made by
methods which are well known to those skilled in the art; some are
commercially available, for example, from Sigma Chemical Company,
PO Box 14508, St. Louis, Mo. 63178. Compounds of Formula II can be
made in accordance with known procedures, or variations thereof
which will be described by: P. Zamecnik, et al., Proc. Natl. Acad.
Sci. USA 89, 838-42 (1981); and K. Ng and L. E. Orgel, Nucleic
Acids Res. 15(8), 3572-80 (1977).
[0144] The topical solution containing the active compound may also
contain a physiologically compatible vehicle, as those skilled in
the ophthalmic art can select using conventional criteria. The
vehicles may be selected from the known ophthalmic vehicles which
include, but are not limited to, saline solution, water polyethers
such as polyethylene glycol, polyvinyls such as polyvinyl alcohol
and povidone, cellulose derivatives such as methylcellulose and
hydroxypropyl methylcellulose, petroleum derivatives such as
mineral oil and white petrolatum, animal fats such as lanolin,
polymers of acrylic acid such as carboxypolymethylene gel,
vegetable fats such as peanut oil and polysaccharides such as
dextrans, and glycosaminoglycans such as sodium hyaluronate and
salts such as sodium chloride and potassium chloride.
[0145] In addition to the topical method of administration
described above, there are various methods of administering the
active compounds of the present invention systemically. One such
means would involve an aerosol suspension of respirable particles
comprised of the active compound, which the subject inhales. The
active compound would be absorbed into the bloodstream via the
lungs or contact the lacrimal tissues via nasolacrimal ducts, and
subsequently contact the lacrimal glands in a pharmaceutically
effective amount. The respirable particles may be liquid or solid,
with a particle size sufficiently small to pass through the mouth
and larynx upon inhalation; in general, particles ranging from
about 1 to 10 microns, but more preferably 1-5 microns, in size are
considered respirable.
[0146] Another means of systemically administering the active
compounds to the eyes of the subject would involve administering a
liquid/liquid suspension in the form of eye drops or eye wash or
nasal drops of a liquid formulation, or a nasal spray of respirable
particles which the subject inhales. Liquid pharmaceutical
compositions of the active compound for producing a nasal spray or
nasal or eye drops may be prepared by combining the active compound
with a suitable vehicle, such as sterile pyrogen free water or
sterile saline by techniques known to those skilled in the art.
[0147] Other means of systemic administration of the active
compound would involve oral administration, in which pharmaceutical
compositions containing compounds of Formula I, II, III or IV are
in the form of tablets, lozenges, aqueous or oily suspensions,
dispersible powders or granules, emulsion, hard or soft capsules,
or syrups or elixirs. Compositions intended for oral use may be
prepared according to any method known to the art for the
manufacture of pharmaceutical compositions and such compositions
may contain one or more agents selected from the group consisting
of sweetening agents, flavoring agents, coloring agents and
preserving agents in order to provide pharmaceutically elegant and
palatable preparations. Tablets contain the active ingredient in
admixture with nontoxic pharmaceutically acceptable excipients
which are suitable for the manufacture of tablets. These excipients
may be, for example, inert diluents, such as calcium carbonate,
sodium carbonate, lactose, calcium phosphate or sodium phosphate;
granulating and disintegrating agents, for example, corn starch, or
alginic acid; binding agents, for example, starch, gelatin or
acacia; and lubricating agents, for example magnesium stearate,
stearic acid or talc. The tablets may be uncoated or they may be
coated by known techniques to delay disintegration and absorption
in the gastrointestinal tract and thereby provide a sustained
action over a longer period. For example, a time delay material
such as glyceryl monostearate or glyceryl distearate may be
employed. Formulations for oral use may also be presented as hard
gelatin capsules wherein the active ingredient is mixed with an
inert solid diluent, for example, calcium carbonate, calcium
phosphate or kaolin, or as soft gelatin capsules wherein the active
ingredient is mixed with water or an oil medium, for example,
peanut oil, liquid paraffin or olive oil.
[0148] Additional means of systemic administration of the active
compound to the eyes of the subject would involve a suppository
form of the active compound, such that a therapeutically effective
amount of the compound reaches the eyes via systemic absorption and
circulation.
[0149] Further means of systemic administration of the active
compound would involve direct intra-operative instillation of a
gel, cream, or liquid suspension form of a therapeutically
effective amount of the active compound.
[0150] Those having skill in the art will recognize that the
starting materials may be varied and additional steps employed to
produce compounds encompassed by the present invention, as
demonstrated by the following examples. In some cases protection of
certain reactive functionalities may be necessary to achieve some
of the above transformations. In general the need for such
protecting groups will be apparent to those skilled in the art of
organic synthesis as well as the conditions necessary to attach and
remove such groups.
[0151] The invention is illustrated further by the following
examples which are not to be construed as limiting the invention in
scope or spirit to the specific procedures described in it. In vivo
examples in accordance with the invention are conducted on rabbits
eyes. Clinical studies with patients afflicted with dry eye disease
provide evidence of therapeutic efficacy in humans.
EXAMPLES
Example 1
Effects of U.sub.2P.sub.4 on Tear Secretion in Rabbits
[0152] U.sub.2P.sub.4 (P.sup.1,P.sup.4-Di(uridine
5'-)tetraphosphate, tetrasodium salt) was formulated as an isotonic
aqueous solution and topically administered to the eyes of albino
rabbits and tear secretion experiments were conducted as a measure
of efficacy in normal rabbits.
[0153] Healthy, male, adult albino New Zealand rabbits (range 2-2.5
kg) were used for these studies. Rabbits were obtained from Elevage
Scientifique des Dombes (Chantillon sur Charlaronne, France).
Animals were observed daily for signs of ill health and only
healthy animals with no ocular abnormalities were used for
experiments. Animals were housed in standard cages in one room
under controlled environmental conditions. Animals had free access
to food and water throughout the study. The test article for all
studies was daily formulated in water and NaCl to make an isotonic
solution.
[0154] U.sub.2P.sub.4 at 0.5%, 5.0% and 8.5% concentrations was
instilled (50 .mu.l) 5 times a day for 14 days into the
conjunctival sac of eight rabbits in separate groups. Tear
secretion was measured using a Schirmer test strip at 0, 5, 15, 30
and 60 minutes after the first and last instillation of the day on
days 1, 7 and 14. The results are compared to separate saline and
untreated control groups.
[0155] All three concentrations of U.sub.2P.sub.4 increased tear
secretion in rabbit eyes over a 60-minute period as compared to
saline control (see FIG. 1).
Example 2
Effects of U.sub.2P.sub.4, dCp.sub.4U and
p-Br-Phenyl-ethenoCp.sub.4U on Schirmer Scores in Rabbits
[0156] This study was designed to investigate the effects of three
synthetic P2Y.sub.2 receptor agonists, U.sub.2P.sub.4, dCp.sub.4U,
and p-Br-phenyl-ethenoCp.sub.4U, on tear fluid secretion following
a single instillation in albino rabbits.
[0157] Each of three cohorts of rabbits (10 animal/cohort) was
given a single 50 .mu.L instillation of isotonic and pH-neutral
solution of 50 mM U.sub.2P.sub.4, dCp.sub.4U, and
p-Br-phenyl-ethenoCp.sub.4U, in one eye per animal. The
contralateral eye was untreated. A fourth control cohort was given
isotonic saline in one eye and untreated in the contralateral eye.
Tear 25 secretion was measured using Schirmer strips placed into
each eye for 15 seconds at baseline (3 hr before first
instillation) and at 10 min, 0.5, 1, 2, and 3 hr
post-instillation.
[0158] U.sub.2P.sub.4, dCp.sub.4U, and p-Br-phenyl-ethenoCp.sub.4U,
significantly increased Schrimer scores following topical
instillation when compared with saline or untreated controls. At 10
minutes post-dosing, the rank order of potency is (highest to
lowest):
U.sub.2P.sub.4.apprxeq.p-Br-Phenyl-ethenoCp.sub.4U>dCp.sub.4U.
At 30 minutes post-dosing, the rank order of potency is:
dCp.sub.4U.apprxeq.U.sub.2P.sub.4>p-Br-Phenyl-ethenoCp.sub.4U.
Tear secretion from U.sub.2P.sub.4- and dCp.sub.4U-treated eyes
returned to pretreatment levels by 1 hour post-dosing, whereas tear
secretion from p-Br-phenyl-ethenoCp.sub.4U-treated eyes remained
slightly elevated for up to 2 hours. The only statistically
significant difference among the three treatment groups was at 1
hour post-treatment, when p-Br-phenyl-ethenoCp.sub.4U showed
significantly higher Schirmer scores than dCp.sub.4U. (see FIG. 2.)
The results showed that three synthetic P2Y.sub.2 receptor agonists
U.sub.2P.sub.4, dCp.sub.4U, and p-Br-phenyl-ethenoCp.sub.4U, all
stimulated tear secretion in rabbits.
Example 3
Dose Ranging Efficacy Trial of U.sub.2P.sub.4 Ophthalmic Solution,
in Patients with Dry Eye
[0159] This study was designed to compare the efficacy and safety
of 4 concentrations (0.5, 1.0, 2.0 and 5.0%) of U.sub.2P.sub.4
(P.sup.1,P.sup.4-Di(uridine 5'-) tetraphosphate, tetrasodium salt)
ophthalmic solution vs. placebo in 158 patients with dry eye
disease.
[0160] Following a one-week placebo lead-in 158, eligible patients
(Schirmer tests.ltoreq.7 mm, evidence of corneal staining, and at
least 2 of 5 symptoms) were randomized to one of the 4
concentrations of U.sub.2P.sub.4 or placebo for a 4-week treatment.
At 4 weeks, 50% of patients receiving U.sub.2P.sub.4 were
re-randomized (masked) back to placebo. Patients were evaluated at
weeks 1, 2, 3, 4, 6 and 1 week post treatment and daily diary cards
were completed.
[0161] One hundred and forty seven patients completed the trial at
12 centers in the United States. The final population had a mean
age of 63 years and most patients were female. The percent change
from baseline for the objective parameters of corneal fluorescein
and the subjective parameters of itching eye and burning/painful
eye for the placebo (P) group, low dose (L) group (0.5 and 1.0%)
and high dose (H) group (2.0 and 5.0%) at weeks 4 and 6 are shown
in Table 1 (a negative change indicates improvement):
3TABLE 1 Change of Objective and Subjective Parmeters. Week 4 Week
6 P L H P L H (n = 52) (n = 50) (n = 47) (n = 52) (n = 23) (n = 26)
Corneal -23% -42%* -32% -26% -46% -44% Staining Itching Eye 1% -15%
-12% -6% -24% -26% Burning/ -2% -12% -17% -10% -30% -28% Painful
Eye *p < 0.05 vs. P (Dunnetts ANCOVA)
[0162] The results showed the U.sub.2P.sub.4 ophthalmic solution
had greater efficacy than placebo on both objective and subjective
parameters of dry eye and is a promising new potential therapy for
this disease.
Example 4
Effects of Diadenosine Polyphosphates on Rabbit Tear Production in
vivo and on Human P2Y Receptors in vitro
[0163] Materials
[0164] UTP and ATP were purchased from Amersham Pharmacia Biotech
(Piscataway, N.J.); UDP, Ap.sub.2A, Ap.sub.3A, Ap.sub.4A,
Ap.sub.5A, Ap.sub.6A and phosphodiesterase were purchased from
Sigma Chemical. Co. (St. Louis, Mo.); 2MeSADP, PPADS, were
purchased from Research Biochemicals International. (Natick,
Mass.). The purity of all nucleotide agonists was established by
HPLC (95-99% purity). Schirmer strips were provided by Allergan
(Spain). Fluo-3-AM was obtained from Molecular Probes (Eugene,
Oreg.). Dulbecco's modified Eagle's medium (DMEM), fetal bovine
serum G-418, and other cell culture reagents were obtained from the
Tissue Culture Facility at the University of North Carolina, or
from Gibco-BRL Life Technologies (Rockville, Md.). 1321N1 human
astrocytoma cells stably expressing the P2Y.sub.1, P2Y.sub.2,
P2Y.sub.4, P2Y.sub.6 or P2Y.sub.11 receptors, and wild-type 1321N1
cell were obtained from the University of North Carolina at Chapel
Hill.
[0165] Animals
[0166] Male New Zealand white rabbits weighing 2.0 to 2.5 kg were
placed in individual cages with free access to food and water and
subjected to regular cycles of light-darkness (12 hours). All the
experiments were performed according to ARVO Statement for the Use
of Animals in Ophthalmic and Vision Research and to the European
Directive 86/609/EEC.
[0167] Measurement of Tear Secretion
[0168] Tear secretion was measured according to the Schirmer test.
Briefly, 10 .mu.l of the test compound at the indicated
concentrations were instilled via pipette in the eye. Thirty
seconds after, a Schirmer strip was placed in the inferior lid
margin of the eye for 5 min. Control experiments were performed by
applying 10 .mu.l of saline solution (NaCl 0.9%). Tear secretion
was measured as the length (mm) of the strip wetted by the
tears.
[0169] Dosing
[0170] Single-dose experiments were carried out by applying 10
.mu.l of the corresponding nucleotide or dinucleotide at a
concentration of 10 .mu.g/.mu.l. Dose-response analysis was
performed by instilling doses ranging from 10.sup.-10 to 10.sup.-4
g/.mu.l, always in a volume of 10 .mu.l. Concentration-response
curves were done by applying different doses in a non-cumulative
fashion in one of the rabbit eyes, with the contralateral eye
receiving the same volume of saline solution (control).
Transformation of g/.mu.l units into molar concentrations was
performed by factoring in the corresponding molecular weight of
each dinucleotide for each data point. The values presented are the
means .+-.S.E.M. of 8 to 12 experiments performed in 36 different
animals. Statistical significance between treated and non-treated
animals was estimated by the Student's t-test.
[0171] Cell Culture
[0172] 1321N1 human astrocytoma cells stably expressing the human
P2Y.sub.1, P2Y.sub.2, P2Y.sub.4, P2Y.sub.6, and P2Y.sub.11
receptors were grown in DMEM containing 4.5 g/l glucose, 5% fetal
bovine serum and 600 .mu.g/ml G-418. For intracellular Ca.sup.2+
measurements, cells were seeded in 96-well black wall/clear bottom
culture plates (#3904 Corning Inc., Corning, N.Y.), at a density of
35,000 cells per well and assays conducted 2 days later when the
cells had reached confluence.
[0173] Intracellular Ca.sup.2+ Measurements
[0174] On the day of the assay, the growth medium in the culture
plates was aspirated and replaced with 2.5 .mu.M Fluo-3-AM in a
final volume of 50 .mu.l and incubated for one hour at 25.degree.
C. Then, the dye was replaced with assay buffer (10 mM KCl, 118 mM
NaCl, 2.5 mM CaCl.sub.2, 1 mM MgCl.sub.2, 10 mM glucose, and 20 mM
HEPES, pH 7.4), using a Columbus Plate Washer, (Tecan Inc.,
Research Triangle Park, N.C.). Intracellular Ca.sup.2+ levels in
response to P2Y receptor agonists was monitored as changes in
fluorescence intensity using a Fluorescent Light Imaging Plate
Reader (FLIPR) (Pendergast et al., 2001) from Molecular Devices
(Sunnyvale, Calif.). Average Fluorescence Units (AFU) corresponding
to peak height were captured on disk and exported for further
analysis. Changes in fluorescence data corresponding to
concentrations of intracellular Ca.sup.2+ were normalized to the
response of the cognate agonists (2MeSADP for P2Y.sub.1 receptor,
ATP for P2Y.sub.2 receptor, UTP for P2Y.sub.4 receptor, UDP for
P2Y.sub.6 receptor, and ATP for P2Y.sub.11 receptor).
[0175] Agonist potencies were calculated using a four-parameter
logistic equation and the GraphPad software package (San Diego,
Calif.). EC.sub.50 values (mean.+-.standard error) represent the
concentration of agonist at which 50% of the maximal effect is
achieved. Three experiments using triplicate assays were conducted
on separate days for each P2Y receptor subtype.
[0176] In order to determine whether or not mononucleotides were
able to modify rabbit tear secretion, single doses of ATP, UTP, ADP
and UDP were instilled via pipette at 10 .mu.g/.mu.l (final volume
10 .mu.l). Thirty seconds after, a Schirmer strip was placed in the
inferior lid margin of the eye for 5minutes. Control experiments
were performed by applying 10 .mu.l of saline solution (NaCl 0.9%).
Tear secretion was measured as the length (mm) of the strip wetted
by the tears and values were expressed as percent saline control
(***P<0.001; **P<0.05) compared to saline solution (Student's
t-test).
[0177] Tear Secretion Results
[0178] As shown in FIG. 3A, among the tested mononucleotides, UTP
and ATP significantly increased Schirmer scores to 160.+-.8% (n=16)
(P<0.001) and 131.+-.6%, respectively (n=12), when compared to
control. UDP and ADP, on the other hand, did not significantly
increase tear secretion, their values being 105.+-.2% for UDP and
107.+-.1% for ADP (n=10).
[0179] When diadenosine polyphosphates were assayed under the same
conditions as the mononucleotides, Ap.sub.4A, Ap.sub.5A and
Ap.sub.6A, significantly increased tear secretion, by 162.+-.3%,
126.+-.6% and 125.+-.15%, respectively (p<0.05, n=12). Neither
Ap.sub.2A nor Ap.sub.3A was able to significantly change tear
secretion rates (95.+-.2% and 89.+-.7%, respectively, n=10) (FIG.
3B).
[0180] Concentration-effect curves of all the dinucleotides in the
range of 10.sup.-10 to 10.sup.-4 g/.mu.l showed pD.sub.2 values for
Ap.sub.4A, Ap.sub.5A and Ap.sub.6A of 5.56.+-.0.03, 5.75.+-.0.12
and 5.50.+-.0.09 (n=8). These values corresponded to EC.sub.50
values of 2.76 .mu.M for Ap.sub.4A, 1.77 for Ap.sub.5A and 3.16
.mu.M for Ap.sub.6A. Ap.sub.4A was the dinucleotide eliciting the
strongest effect, 162.+-.2.4%, with Ap.sub.5A and Ap.sub.6A
exhibiting similar maximal effects (125.+-.7%) (FIG. 4).
Diadenosine diphosphate and diadenosine triphosphate failed to
produce any change on tear secretion even at the highest
concentrations assayed (n=8).
[0181] The lack of effect of UDP (P2Y.sub.6 agonist) and ADP
(P2Y.sub.1 agonist), and moreover the full effect of Ap.sub.4A,
strongly suggested the involvement of a P2Y.sub.2 receptor in this
physiological action.
[0182] P2Y Receptor Results
[0183] Adenine dinucleotides were tested for their ability to
activate human P2Y.sub.1, P2Y.sub.2, P2Y.sub.4, P2Y.sub.6 and
P2Y.sub.11 receptors as measured by the mobilization of
intracellular Ca.sup.2+. P2Y.sub.4, P2Y.sub.6 and P2Y.sub.11 were
insensitive to diadenosine polyphosphates and were only stimulated
by different mononucleotides (results not shown).
[0184] Two receptors, P2Y.sub.1 and P2Y.sub.2, were fully activated
by diadenosine polyphosphates with different pharmacological
patterns (FIGS. 5A and B). The activity of Ap.sub.nA on human
P2Y.sub.1 and P2Y.sub.2 receptors expressed in 01321 astrocytoma
cells are shown in Table 2. The P2Y.sub.1 receptor was fully
activated by submicromolar concentrations of Ap.sub.3A; the
P2Y.sub.2 receptor was activated by Ap.sub.4A at a similar low
concentration.
4TABLE 2 EC.sub.50 and pD.sub.2 values for intracellular calcium
mobilization for Ap.sub.nA on human P2Y.sub.1 and P2Y.sub.2
receptors expressed in 1321 astrocytoma cells (n = 3). EC.sub.50
(.mu.M) (pD.sub.2) Compound P2Y.sub.1 receptor P2Y.sub.2 receptor
Ap.sub.2A 5.67 (5.24) N/A Ap.sub.3A 0.009 (8.05) 19.6 (4.70)
Ap.sub.4A 0.16 (6.77) 0.093 (7.03) Ap.sub.5A 1.66 (5.77) 2.64
(5.57) Ap.sub.6A 1.77 (5.75) 5.18 (5.28)
[0185] The invention and the manner and process of making and using
it are now described in such full, clear, concise and exact terms
as to enable any person skilled in the art to which it pertains, to
make and use the same. It is to be understood that the foregoing
describes preferred embodiments of the present invention and that
modifications may be made therein without departing from the spirit
or scope of the present invention as set forth in the claims. To
particularly point out and distinctly claim the subject matter
regarded as invention, the following claims conclude this
specification.
* * * * *